Cosmetic Changes

More and more people want younger, fresher looking skin. What they don't want is to go under the knife.

| Published: 2013-02-22 13:37

Kim Foley is perfectly happy with her looks. She’d just like to keep them as long as possible. So, not long after turning 50, Foley began budgeting $1,500 annually for what she calls “beauty treatments,” including a variety of nonsurgical cosmetic procedures.

“I was very hesitant to do anything to my face, as most people are,” says Foley, who lives in Bethesda and declined to give her age. “I didn’t want to look any different. I didn’t want to look like I’d done something. I just wanted to do something minor that would defer aging.”

A makeup artist who lectures around the country on how people can enhance their professional credibility, Foley says she has had treatments to reduce wrinkles and frown lines, tighten her skin, and get rid of age spots and sun damage. “I’m going to put off surgery as long as I can,” she says. “I’m not seeking youth. I’m seeking to find my personal best right now.”

Foley is part of a growing national trend. Over the past decade or so, the number of “minimally invasive”—or nonsurgical—cosmetic procedures has more than doubled in the United States, while surgical cosmetic procedures have declined by more than 17 percent, according to the American Society of Plastic Surgeons.

The society counts only those procedures performed by board-certified doctors in any specialty, so its statistics most likely under-represent the actual number of nonsurgical cosmetic procedures. Some of those procedures are performed by doctors who aren’t board-certified or by physician assistants, nurses or licensed aestheticians, which Maryland regulations allow as long as they have been properly trained and, in the case of the non-physicians, work under a doctor’s direction.

Foley’s dermatologist, Dr. Eric Finzi of Chevy Chase, says two main factors have contributed to the boom in nonsurgical cosmetic procedures. For one, he says, “the noninvasive tools have gotten much better.” The newer tools include Restylane, Juvéderm and other facial fillers, and “intense pulsed light” or IPL.

The other main attraction of nonsurgical cosmetic treatments is that they require little if any downtime, Finzi says. “Most of us cannot afford, in our busy schedule, to be off for 10 days and look miserable, as might be required after surgery,” he says. And, says Bethesda dermatologist David Green, any kind of surgery carries the risk of complications that don’t arise with nonsurgical procedures.

Plus, even the most expensive minimally invasive procedures, which can range up to $3,000 or so, are cheaper than surgery, an important consideration since insurance doesn’t cover elective cosmetic procedures. According to The American Society for Aesthetic Plastic Surgery, the average U.S. surgeon’s fee for a face-lift in 2011 was just under $6,500, and that didn’t include the anesthesiologist’s or facility’s fees.

“The truth is, you can sell people anything,” Rockville dermatologist Matthew Katz says. “You can make people believe anything works.” But “if you need a tummy tuck, you need a tummy tuck. If you need a face-lift, you need a face-lift.” More often than not, the people who most benefit from nonsurgical procedures are “the ones who need them the least,” Chevy Chase plastic surgeon Navin Singh says.

Singh, who offers nonsurgical treatments such as fillers and Botox, as well as surgery, says he regularly encounters patients with unrealistic expectations for the minimally invasive approach.

Patients will ask if he can treat them without surgery, and he says he’ll tell them, “I can, but it’s really throwing money away. Frankly, the best bang for your buck would be surgery.”

For those who are middle-aged and younger, though, nonsurgical treatments can help to freshen their appearance, doctors say. Patients in this age range often opt for a combination of treatments such as Botox to erase frown lines on the forehead and fillers to minimize the nasolabial folds—“laugh lines”—that run from the sides of the nose to the corners of the mouth. Some patients choose nonsurgical treatments such as lasers to improve the texture of their skin, in conjunction with a face-lift.

But patients should know that treatments may need to be repeated because the effects of many minimally invasive procedures wear off over time, doctors say.

One of the most expensive nonsurgical treatments is Thermage, promoted as a way to tighten skin on the face and other parts of the body. It ranges from about $1,500 to $3,000 per treatment, depending on how much skin is treated. According to the Thermage website, the procedure uses “radiofrequency energy to kick-start the body’s own natural renewal process.” That process is the production of collagen, which strengthens the dermis, the layer of skin that’s beneath the epidermis, which is the outermost layer of skin cells. The treatment, involving alternately heating and cooling the skin, can be painful, says Finzi, who gives patients a painkiller to make them more comfortable.

Thermage has received mixed reviews from patients on websites that are devoted to cosmetic procedures. Finzi says he’s not surprised. “The way to look at Thermage is it’s not a slam dunk or guaranteed home run,” he says, and doctors can’t predict who’s most likely to benefit from the procedure.

According to the manufacturer, some people see improvement right away, but it can take as long as six months to see the full effect. Finzi says some never see a change.

Foley is one of Finzi’s satisfied Thermage customers. She says the effect was subtle, but that’s what she wanted. She didn’t tell her husband that she was getting the treatment because she wanted to see if he noticed a difference afterward. “Eventually he said, ‘I don’t know why, but you just look so good,’ ” Foley says. “It obviously changed the way I looked.”

In intense pulsed light therapy, light energy is converted to heat energy to treat conditions including age spots, sun damage, warts, scars, freckles and spider veins. IPL targets the dermis without affecting the epidermis. “It is not a ‘come in and go back to work and look like nothing’s been done’ ” kind of treatment, Katz says, because the spots get “pretty dark and crusty” for several days after IPL before they go away. Of course, says Katz, who charges $200 to $400 per treatment, some people are more self-conscious about the darkened spots than others.